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ILECTRICAL PERMIT AP?LICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 1 (E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: 3501 Colby Avenue Suite#103 <br /> BUILDING AREA(if residential,new construction, remodel,or addition) 4000 SF <br /> BUILDING TYPE: 0 SFR-DETACHED El SFR-ATTACHED 13 DUPLEX 11 MULTI-FAMILY-#OF UNITS: IR COMMERCIAL <br /> USE;F BUILDING: Office for CommonWealth <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ 10,000 <br /> NUMBER OF DEVICES if low voltage): 86 <br /> FIRE ALARM? 0 YES 3 NO <br /> ASSOCIATED BUILDING PERMrr# if applicable): <br /> DESCRIPTION OF WORK: Install 86 telecommunications cables to 43 locations <br /> CONTACT INFORMATION <br /> OWNER NAME: TENANT NAME(If Commercial): CommonWealth <br /> OWNER MAILING ADDRESS: STREET <br /> CITY STATE Z!p <br /> OWNER PHONE: 1OWNER EMAIL: <br /> CONTRACTOR NAME- PowerCorn, Inc, <br /> CONTRACTOR ADDRESS: STREET 22122 20th Ave SE <br /> CITY Bothell STATE WA zip 98021 <br /> CONTRACTOR PHONE: (425)489-8549, ext. 1717 1CONTRACTOR EMAIL: krinaldi@callpowercom.com <br /> CONTRACTOR LIC.#(REQUIRED): POWERI'937MJ CITY <br /> OF EVERETT BUSINESS LIC.#(REQUIRED): 040411 <br /> PRIMARY CONTACT: 0 OWNER rKI CONTRACTOR 1-1 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: (425)489-8549, ext 1717 <br /> CJ Santeford CONTACT EMAIL: cjsanteford@callpowercom.com <br /> AGREEMENT,T hereby certify that I have read and examined this application and know the same to be true and correct, Ali provisions of laws and ordinances governing this <br /> type of work will be completed whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any other state or <br /> local law regulating construction or the performance of construction. That I am authorized by the owner of this property to perform the work for which application is made and I <br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC, <br /> City of Everett Official Use Only <br /> FEE <br /> PERMIT# <br /> Owner/Authorized Agent Signature Date (Revised 10/12'2015) <br />